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From principles of oxygen delivery and patient assessment, through rapid sequence induction of anaesthesia and tracheal intubation, to the difficult and failed emergency airway, this book from an expert team of clinicians guides the reader through every aspect of emergency airway management. Retaining the concise, accessible format of the first edition, it includes a new section on human factors and improving teamwork and performance, an expanded special circumstances section, and a summary of the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society and its implications for practice. Updated guidelines, new technologies such as videolaryngoscopy, and recent evidence have all been incorporated into the chapter content, ensuring that the book reflects best current practice. This thoroughly updated new edition remains an essential resource for navigating a highly challenging clinical scenario and will be of value to emergency medicine, intensive care, anaesthesia and acute medicine clinicians.
Acute heart failure (AHF) may arise from systolic or diastolic dysfunction, rhythm disorder or preload and afterload mismatch from various aetiologies. The strongest sign is presence of a S3 or gallop rhythm on auscultation. Other clinical signs depend on the aetiology of AHF and its correlation with the history helps guide further investigation and treatment. The investigation is performed by electrocardiogram, and imaging techniques such as chest X-ray, computed tomography (CT), and echocardiography. For optimal management of AHF, full blood count, clotting, urea and electrolytes, blood glucose, cardiac enzymes, inflammatory markers and arterial blood gas analysis are recommended. The other investigations for AHF include coronary angiography, endomyocardial biopsy, and CT angiogram. The invasive monitoring of AHF is performed by arterial line, central venous lines, pulmonary artery flotation catheter and echocardiography. The management of AHF includes ventilatory support, the use of inotropes and renal replacement therapy.
Mechanical ventilation is in general indicated where established or impending respiratory failure exists. Respiratory failure occurs when pulmonary gas exchange is sufficiently impaired to cause hypoxaemia with or without hypercarbia. The respiratory failure is classified into two broad categories: Type 1 (or hypoxaemic) and Type 2 (or hypercarbic) respiratory failure. This chapter talks about mechanical ventilators, airway pressure, and flow and derived volumes. The different modes of ventilation are: volume control ventilation, pressure control ventilation, mandatory breaths and spontaneous breaths. The chapter reviews alternative ventilation modes, practical aspects of mechanical ventilation, and complications of mechanical ventilation. It explains different ventilatory strategies for specific conditions such as acute lung injury/acute respiratory distress syndrome, chronic obstructive pulmonary disease, acute asthma and brain injury. A care bundle approach for the care of a ventilated patient should include thromboprophylaxis, gastric protection and evaluation of sedation status.
After gallstones, alcohol is the second most common cause of acute pancreatitis. The mechanism of alcohol-induced acute pancreatitis is incompletely understood, although some evidence points to increased sensitivity of acinar cell cholecystokinin receptors leading to increased release of trypsin. Patients typically present with pepigastric pain, often radiating to the back, accompanied by nausea and vomiting. On account of the wide spectrum of disease severity in acute pancreatitis there is particular interest in prognostic indicators that may help to determine the requirement for therapeutic interventions. A number of scoring systems such as Glasgow score, have been developed to attempt risk stratification in acute pancreatitis. The mainstay of treatment in severe acute pancreatitis is supportive care. The mortality associated with the first peak in the biphasic mortality curve is attributable to systemic inflammatory response and multiple organ failure. Full intensive care support may be necessary including ventilatory, cardiovascular and renal support.